Business

Restaurant Insurance Quote Request

Complete the following information if you would like to obtain a quote. Please understand this is not an application. An application will be sent to you if coverage is desired.

All information provided on this information sheet is confidential and will be used solely for the purpose of developing a quote for you.

Personal Information

* Last Name

* First Name

Business Name

Street Address

City

State

Zip Code

Phone Number

Alternate Telephone

Fax Number

* Email Address

Property Information

Property Street Address

City

State

Zip Code

Total square footage of the building your business is in

Total square footage of your business only

Total square footage of the customer area only

How many stories is it?

If it's two stories, what is the ground floor square footage?

What is the construction type?

What type of roof covering?

Was the roof updated?

Yes

No

If yes, what year?

What is the distance to fire protection?

Is the business in a brush area?

Yes

No

Do you have a storage area more than 1500 Sq. Ft.?

Yes

No

Are there smoke detectors at this location?

Yes

No

Are there fire extinguishers?

Yes

No

Does the building have interior automatic fire sprinklers?

Yes

No

Is there a fire alarm?

Yes

No

Is there a theft alarm?

Yes

No

Are there deadbolts on all doors?

Yes

No

Are there circuit breakers?

Yes

No

Is the electrical updated?

Yes

No

Is the heating / air conditioning thermostatically controlled?

Yes

No

Is the heating/ air conditioning central?

Yes

No

Has the plumbing been updated?

Yes

No

If yes, what year?

Is the parking lot under your protection?

Yes

No

Underwriting Information

What is the nature of your business?

Number of owners

Number of Employees

Payroll of Owners

Payroll of Employees

Total annual gross receipts

Total annual hard liquor receipts

Total annual beer and wine receipts

Total annual food gross receipts

Business License Number

License Type

Years of experience

Years operated under current name

Is this business open 24 hours a day?

Yes

No

Is there filling of propane tanks?

Yes

No

Please describe the nature of your business and ANY unusual exposures:

Entertainment Information

Is there entertainment?

Yes

No

If yes, please describe

Is there live music?

Yes

No

If yes, what size is the dance floor and how many nights per week is there dancing?

Are there any coin operated amusement devices?

Yes

No

If yes, please describe

Are there any pool tables?

Yes

No

If yes, how many and are they coin operated?

Are there any bouncers, doormen, ID checkers, armed or security guards?

Yes

No

If yes, how many of each? (list their job duties and employer)

Are there any contests or exhibition?

Yes

No

If yes, describe events.

Are there any audience participation events?

Yes

No

If yes, describe events.

Do you sponsor any sporting events?

Yes

No

If yes, describe events.

Do you have any other type of entertainment?

Yes

No

If yes, describe events.

Cooking Information

Describe the cooking devices at your business.

Is there tableside cooking?

Yes

No

Is there an automatic suppression system?

Yes

No

If yes, do they protect all hoods, ducts and griddles?

Yes

No

Is there any deep frying?

Yes

No

If yes, is there a high limit shutoff?

Yes

No

Do you have an outside cleaning service for the hoods and duct system?

Yes

No

How often are hood and duct cleaned?

Is there any manufacturing, mixing, re-labeling or repackaging of products?

Yes

No

Is there any delivery service?

Yes

No

Is there any catering service?

Yes

No

Miscellaneous and Claims Information

Were there any losses or claims in the last 5 years?

Yes

No

If yes, what is the date, amount paid and description of each loss or claim?

Current Insurance Company

How much are you paying now?

What is the renewal date?

Has insurance ever been cancelled?

Yes

No

If yes, describe.

Have you ever had regulatory violations or citations?

Yes

No

If yes, describe.

Are employees trained on how to handle minors or intoxicated customers?

Yes

No

If yes, describe.

Coverage Information

What building coverage is requested?

What other structures is requested?

What business contents is requested?

What is the loss of use coverage requested?

What is the liability limit requested?

What policy deductible is requested?

Questions or Comments

Best Time To Contact You

Please let us know the best time to call and discuss your quote.

Morning

Afternoon

Evening

Anytime

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Integrity Financial has a diverse portfolio of products designed to protect what you value most. That is no easy task! Your life is valuable, as are your security, income, health, and financial stability. Securing each of these categories requires a variety of products depending on your specific needs. No matter what you choose, we're here: Protecting your Future, Empowering your Present.

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